D. Health and Welfare

1. There is continuous monitoring of the health and welfare of waiver participant and remediation actions are initiated when appropriate.

Activities:

The SC serves as a liaison between waiver providers facilitating communication regarding issues pertinent to the waiver participant's health and welfare.

The SC will provide all waiver participants with a Waiver Contact Sheet (refer to Appendix C – form C.6) listing SC, other waiver service providers, RRDS, QMS and DOH WMS. This information will be updated and provided to the waiver participant if any entity should change. These contacts allow for easier accessibility for waiver participants to communicate concerns regarding health and welfare.

At least every six (6) months, the SC will facilitate Team Meetings with the waiver participant, anyone he/she chooses to attend, service providers and other key parties to review and revise the SP.

Every SP and PPO will be reviewed by the RRDS to assure the waiver participant's health and welfare needs are being met.

The SC will conduct face-to-face visits with the waiver participant based on the participant's health and welfare needs.

All waiver provider staff will be trained to observe and report changes in the waiver participant's behavioral, physical and cognitive functioning and the process to follow if concerns arise.

DOH WMS monitors calls received from the NHTD Complaint Line for trends.

All SRI reports received will be investigated according to policy and procedure. (refer to Section X – Incident Reporting Policy and Complaint Procedure).

On an ongoing basis, the QMS reviews the SRIs for trends and, as needed, the QMS or the DOH WMS may provide technical assistance to waiver providers.

Waiver providers submit annual reports to the QMS who reviews and analyzes the information in their region and sends the report to the DOH WMS.

DOH WMS initiates the development of a Quality Advisory Board to review statewide trends with a focus on health and welfare.

The data gathered regarding this assurance must be included in the RRDS and/or QMS Quarterly Reports for review by DOH WMS. That staff, in consultation with the QMS and RRDS will evaluate the need to change and/or improve policies/procedures.

If warranted, DOH WMS initiates additional remediation actions including restriction of a provider's opportunity level (vendor hold) for providing services to participants or termination of a provider agreement.

DOH WMS manages system performance ongoing based on the outcome of trend analysis, including SRI, complaints/grievances and Participant Satisfaction Surveys.

2. The state, on an on-going basis, identifies and addresses and seeks to prevent the occurrence of abuse, neglect and exploitation (SRI policy).

Activities:

This Program Manual provides each waiver provider with the policies and procedures for SRI including abuse, neglect and exploitation reporting, investigation and monitoring of outcomes.

The Program Manual describes the waiver provider's need to have a SIRC which has the responsibility for investigating reports of SRI and Recordable incidents, assuring appropriate and immediate corrective or disciplinary action has been taken and preventive measures are in place. Waiver providers must submit an annual report for review to the QMS. The QMS analyzes the data for trends and makes recommendations for changes/improvements on a provider and regional level. This data is compiled and sent by the QMS to DOH WMS with a copy forwarded to the RRDS.

The QMS is the primary party to provide training regarding the SRI policy. The RRDS is available for any assistance that may be needed.

During surveys, DOH will review a waiver provider's policies and procedures for managing complaints and grievances. The Provider's complaint/grievance log is reviewed to assure appropriate documentation, investigation and resolution has occurred within timeframes specified in the NHTD Program Manual. Results of these provider surveys are forwarded to DOH WMS, QMS and RRDS for review, discussion and development/implementation of Remediation and/or Improvement initiatives. DOH WMS maintain survey results in a database for regional and statewide trend analysis.

The QMS is the entity responsible for the management of the NHTD SRIs Policy and is responsible for alerting the DOH WMS of the most serious reports of allegations.

To measure system performance and to identify active or potential instances of abuse, neglect and/or exploitation, the QMS annually conducts a random sample of face-to-face Participant Satisfaction Surveys.

DOH WMS reviews Participant Satisfaction Surveys conducted by the QMS, analyzes these for trends and identifies any warranted programmatic changes.

To meet this assurance, the DOH Waiver Management unit serves as a centralized collection site to receive data compiled from NHTD Complaint Line calls, SRI, Provider survey outcomes as well as quarterly and annual reports. Data is analyzed by staff for regional and statewide trends. Outcomes are reviewed with the QMS and RRDS for needed interventions which may include additional training programs, changes and/or improvements in policy/procedure, restriction of provider opportunity level (Vendor Hold) and/or termination of provider agreement.